Hansen Disease

BY DR.VIVEK SAHU
Dr. Apeksha Pramodrao Kohale
Junior resident
AP Dept. Of Dermatology
Depatment – Dermatology, Venereology and Leprosy
Hansen’s Disease
A chronic infectious disease caused by acid fast bacilli-
Mycobacterium leprae
Discovered by Gerard Armauer Hansen in Norway in 1873.

Mainly affects macrophages and schwann cells .

M. Leprae is an -obligate intracellular organism;
-acid fast ,
-straight/ slightly curved rod shaped,
-gram positive bacillus
-it cannot be cultured in artificial media.
Grows best in below 37ºC - cooler areas like skin, peripheral nerve,
upper respiratory tract and testis except warmer area.
Organism -killed by boiling and autoclaving .

They can be remain dormant in various body sites and tissues

causing relapse.
Found large quantities in skin of earlobes ,face, buttocks.
 Generation time (time taken by a bacterium to divide into 2 cell )-

11-13 days ( M.leprae )

Incubation period : 2-7 years

1. Probably spread by the respiratory route; nasal discharge from
Transmission
infectecd/untreated patients with multibacillary disease.

2. Through broken skin.

3. Contact: To a smaller extent, by skin to skin contact.
4. In utero transmission( rare )
5. Transmission through ingestion (breast milk).
6. Contact with armadillos (handling, killing, )

Nine banded armadillos common in Southern United States.

 Prevalence:
- Prior to the MDT, the southern states of Tamil Nadu and Andhra Pradesh
had the highest prevalence.
- Today, hyperendemic areas of India are in the north and east.
- Currently, 7 States in India- Bihar, Uttar Pradesh, Chhattisgarh, Jharkhand,
Maharashtra, Odisha and west Bengal contribute almost 3/4th of the total
leprosy burden (74.9% new leprosy cases detected).
India achieved elimination target in December 2005.
Leprosy occurs in both the sexes, male > females(2:1).
RISK FACTORS

1. Close contact
2. low education
3. poor hygiene
4. Age : 20-30 yrs
5. Immunosuppression
 Ridley-Jopling Classification(1966)

Most scientific, widelyaccepted and research- oriented

classification that is based on four parameters
1. Clinical features,
2. Histological features,
3. Bacteriological features (slit-skin smears) and
4. Immunological features (lepromin testing)
Based on all these four parameters, leprosy is divided into five groups

1. TT: Tuberculoid leprosy

2. BT: Borderline tuberculoid leprosy
3. BB: Borderline-borderline leprosy
4. BL: Borderline-lepromatous leprosy
5. LL: lepromatous leprosy
WHO Classification of Leprosy
WHO classification (with its modifications) is most used system in
leprosy control programs.

Ridley Jopling classification is most widely used for

research and academic purposes.

CLINICAL FEATURES
Clinical leprosy varies from an insignificant hypopigmented,
hypoesthetic patch which heals spontaneously to widespread
damage to peripheral nerves, eyes, bones, muscles, or other tissues,
with deformity and disability.
There is always nerve damage in leprosy.
-vary from microscopic neuritis in indeterminate leprosy to
thickened nerve in borderline spectrum of the disease.
Most of the clinical features in leprosy are due to the host response
to the presence of the bacilli than of changes to bacillary invasion.
Earlymanifestations in
manifestations of leprosy leprosy
Anesthesia of a part of hand or foot
Bilateral pedal edema
Epistaxis
Multiple, vague, non anesthetic patches
Muscular weakness without skin lesions
Neuritic pain
Non healing plantar ulcers
Tenosynovitis
Well defined patch with anesthesia
 Cardinal signs of leprosy
There are three cardinal signs—
A) Anesthetic skin lesions:
This includes macules, papules,
plaques, or nodules in which there is
definite loss of sensation to light
touch, pain, or temperature.
There may also be alteration in skin
color, texture, or hair growth in
addition.
B) Nerve enlargement:
This indicates cord-like thickening
of peripheral nerves.
C) Demonstration of M. leprae:
( Presence of acid-fast bacilli in slit skin smear)
The sites - include earlobe, forehead, buttock, and from the patch.
Though skin smears from 13 sites were frequently practiced earlier,
at present it is recommended from 4* sites only.
Bacilli may be demonstrated from the skin, nasal mucosa, pulp of
fingers or from nose blows.
Indeterminate Leprosy (IL)
Indeterminate leprosy is the most common
presentation in children ranging from 20–80%.
This is the first sign of leprosy, which is observed
even before the host develops immune responses to
M. leprae.
If the host response is good, the lesion heals without
forming any sequel.
 Tuberculoid Leprosy (TT)

Ref : IAL Textbook of

Leprosy
Borderline Tuberculoid (BT)
Borderline Borderline (BB)
Borderline Lepromatous (BL)
Lepromatous Leprosy (LL)
Other Manifestations of Leprosy

Lagophthalmos,
Uveitis,
Corneal ulceration,
Perforation and opacity
Blindness.
Diagnosis:
. Mainly Clinical as discussed earlier
. Slit Skin Smear
. Nerve examination
Slit skin smear:
Nerve examination:
Immunoprophylaxis ( BCG vaccine ) – Children may
benefit more as the protection decrease with passage of time.
THANK
YOU

NLEP